Patterns of cigarette smoking among Hispanics in the United States: results from HHANES 1982-84

Acculturation level and change in cigarette consumption behaviors among diverse Hispanics/Latinos: the Hispanic Community Health Study/Study of Latinos

PURPOSE

To study associations between language acculturation level and changes in cigarette consumption among the diverse and growing U.S.-based Hispanic/Latino population and inform culturally tailored smoking prevention and cessation strategies.

METHODS

In the Hispanic Community Health Survey/Study of Latinos cohort, we used cigarette consumption behaviors at baseline (2008-2011) and follow-up (2014-2017) and a modified Short Acculturation Scale for Hispanics (SASH) language subscale to measure associations of language acculturation (unidimensional) with changes in cigarette consumption and quitting rates. Weighted multivariable linear and logistic regressions were stratified by daily (n = 1397) and nondaily (n = 633) smoking, and either sex, educational attainment, or migration status.

RESULTS

Smokers at baseline (n = 2030) on average were aged 42 years old (SE = 0.5) with a mean SASH-language score of 2.3 (SE = 0.1; range = 1-5), indicating more Spanish language use. Among male daily smokers, we observed increases in smoked cigarettes-per-day (CPD) with unit increases in SASH-language score (1.08, 95% CI: 0.24-1.92). Associations with acculturation trended toward greater increases in CPD and lower odds of quitting as educational attainment increased.

CONCLUSIONS

Language acculturation level is an important determinant for increased smoking behaviors, particularly among men. Our findings are significant in informing smoking reduction programs for the Hispanic/Latino population.

Disparities in Smoking Behavior by Race/Ethnicity in 10 Diverse Communities in Chicago: Findings from Sinai Community Health Survey 2.0

Disparities in smoking prevalence persist among and within racial/ethnic groups in the U.S. This study aimed to identify racial/ethnic smoking behavior disparities in Chicago between 2015 and 2016. We used data from the Sinai Community Health Survey 2.0, a population-based survey conducted among adults living in ten diverse communities in Chicago. A total of 1543 adults completed the survey. We estimated the prevalence of smoking behavior among participants who had smoked at least 100 cigarettes in their lives (N = 598). We stratified by race/ethnicity and sex, reporting statistically significant differences at p < 0.05 threshold. Current smoking was highest among NHBs (40%), followed by Puerto Ricans (28%), NHWs (24%), and Mexicans (13%). Among participants who had smoked 100 cigarettes in their life, over 60% of Puerto Rican (65%) and NHB (63%) participants were daily smokers. Although 72% of NHB smokers tried to quit smoking in the previous year, only 15% of them quit smoking for more than 12 months. Among Puerto Rican current smokers, 44% smoked a pack of cigarettes per day or more while only 6% of NHBs smoked more than a pack a day. Only 20% of Mexican participants were advised by a health professional to quit smoking in the past year. Among Puerto Rican females, 55% started smoking before the age of 15. We found important differences in smoking behavior by race/ethnicity groups and sex. These disparities highlight the importance of implementing targeted evidence-based strategies to reduce tobacco use, particularly among those groups with the highest prevalence.

A Meta-Analysis of Latinx Acculturation and Intimate Partner Violence

OBJECTIVE

Intimate partner violence (IPV) is a serious public health concern that affects many Latinx couples. The present study conducted a systematic review and meta-analysis to quantitatively assess acculturation as a predictor of IPV among Latinxs and subgroup analyses to evaluate the effect size by gender and type of acculturation measure.

METHOD

The meta-analysis implemented the preferred reporting items for systematic reviews and meta-analyses guidelines to retrieve studies assessing the relationship between acculturation and intimate partner victimization among foreign-born and U.S.-born Latinx adults. A fixed effects model (FEM) and a random effects model (REM) were employed. Additional subgroup analyses examined the strength of the relationship by gender and type of acculturation measure.

RESULTS

The meta-analysis included 27 independent effect sizes across 21 studies. An REM yielded a weighted average correlation of .11 (95% confidence interval [.02, .20]). The strength of the correlation differed by scale and ranged from -.003 to .47. For both men and women, higher acculturation was associated with increased IPV.

CONCLUSIONS

Our results yielded three important findings: (1) the overall effect of acculturation on IPV is relatively small, (2) acculturation differentially influences male-to-female and female-to-male partner violence, and (3) the strength of the correlation between acculturation and IPV differs by scale. This body of work provides evidence for the effect of acculturation on IPV, with potential implications for interventions targeting Latinxs.

Heterogeneity in Current Cigarette Smoking among Hispanic/Latino Heritage Groups in New York City, 2003-2016

Objectives

We assessed differences in trends, prevalence, and sociodemographic correlates of current smoking among several predominant Hispanic/Latino heritage groups (Puerto Ricans, Dominicans, Central and South Americans, and other Hispanic/Latinos) in New York City (NYC). We additionally compared current smoking prevalence between heritage groups and non-Hispanic/Latino Whites.

Design and Methods

Data from the Community Health Survey, a representative, dual-frame landline/cellphone survey, were analyzed to assess age-adjusted prevalence of current smoking, separately among heritage groups from 2003-2016. Logistic regression was used to estimate odds ratios and 95% CIs for current smoking by Hispanic/Latino heritage group relative to non-Hispanic/Latino Whites in combined 2012-2016 data. Logistic regression was also used to examine correlates of smoking among each heritage group, separately.

Results

Between 2003-2016, current smoking prevalence decreased among all Hispanic/Latinos heritage groups except Puerto Ricans, who had the highest smoking prevalence among all groups examined. Sex-stratified trend analyses showed decreases among all groups except Puerto Rican and other Hispanic/Latino males. In multivariable-adjusted models, relative to non-Hispanic/Latino Whites, there was no association with current smoking among Puerto Ricans, but odds of smoking were lower among all other heritage groups. Female sex was inversely associated with current smoking among all heritage groups, and acculturation was positively associated with smoking among all groups except Central/South Americans. Lower educational attainment was strongly associated with smoking among Puerto Ricans.

Conclusions

Lack of progress in reducing smoking among Puerto Ricans in NYC is concerning. Opportunities for cultural, sex-specific, and other targeted outreach to this community should be explored.

Emotion dysregulation and cigarette dependence, perceptions of quitting, and problems during quit attempts among Spanish-speaking Latinx adult smokers

Latinx smokers in the United States (U.S.) represent an understudied health disparities group in terms of tobacco use. Despite scientific interest to elucidate individual difference risk factors for smoking, there is limited understanding of how emotional dysregulation relates to smoking outcomes among Spanish-speaking Latinx smokers. The purpose of the present investigation was therefore to explore emotion dysregulation in relation to cigarette dependence, perceived barriers for quitting, and severity of problems experienced during prior quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, M_age = 33.3 years, SD = 9.81). Results indicated that emotion dysregulation was significantly related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Notably, the effects accounted for 7% to 15% of variance and were evident after adjusting for gender, income, education, number of medical conditions, depression symptoms, non-alcohol drug use, and alcohol consumption. The findings provide novel evidence that emotion dysregulation may represent an important individual difference factor for better understanding smoking-related outcomes among Latinx smokers and supports the need for greater attention to this affective vulnerability during smoking cessation treatment.

Pain intensity and tobacco smoking among Latinx Spanish-speaking adult smokers

Some research suggests that pain intensity is greater among Latinx persons compared to non-Hispanic-Whites, and that the experience of more intense pain among this group is related to poorer mental health and impairment. Yet, the degree to which pain-smoking relations generalize to Latinx smokers is unknown. The present study tested whether past-month pain intensity among adult Latinx smokers was related to cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. Participants were 363 Spanish-speaking Latinx daily smokers (58.7% female, M_age = 33.3 years, SD = 9.81). Consistent with prediction, current pain intensity was significantly related to greater cigarette dependence, perceived barriers for quitting, and problems experienced during past quit attempts. These novel data provide preliminary evidence that individual differences in the intensity of experienced pain in the past month is related to a range of clinically-significant smoking variables among a large sample of Latinx smokers. The findings suggest that pain intensity may be important to Latinx smokers, a group that often showcases pain-related disparities compared to other racial/ethnic groups.

How Does Acculturation Influence Smoking Behavior Among Latinos? The Role of Education and National Background

Introduction

As Latinos acculturate, they are assumed to smoke at higher rates. This study investigated the relationship between acculturation level, educational attainment, and cigarette smoking by gender and national background among Latinos.

Methods

Data from the 2009-2012 National Health Interview Survey were analyzed and participants included 1,111 Cubans, 813 Dominicans, 13,281 Mexicans, and 2,197 Puerto Ricans. Multivariable logistic regression was used to model acculturation and educational predictors of current smoking, stratified by gender and national background. Acculturation level was categorized into less acculturated, bicultural, and more acculturated by combining birthplace and language preference. Current cigarette smoking was defined by self-reported use every day or some days among those who ever smoked at least 100 cigarettes.

Results

Most respondents were interviewed in English (62%) and had a high school education or less (60%), but only 39% were US-born. Overall, 17.8% of men and 9.6% of women reported current smoking. By national background, smoking prevalence was highest among Puerto Ricans (16% of women and 23% of men) and lowest among Dominicans (6% of women and 10% of men). More acculturated Mexican women and men had significantly higher odds of current smoking (OR=2.94; 95% CI=2.01, 4.31 and OR=1.88; 95% CI=1.39, 2.55; respectively). Mexican men who were more acculturated and had greater levels of educational attainment had lower odds of smoking (OR=.84; 95% CI=.74, .96).

Conclusions

The relationship between acculturation and health behaviors among Latinos is influenced by education and should be considered by public health and clinician stakeholders when developing or adapting tobacco control strategies.

Smoking Among Hispanic/Latino Nationality Groups and Whites, Comparisons Between California and the United States

Introduction

Although California is home to the largest Hispanic/Latino population, few studies have compared smoking behavior trends of Hispanic/Latino nationality groups in California to the remaining United States, which may identify the impact of the states antitobacco efforts on these groups. This study compared smoking status, frequency, and intensity among Mexican Americans, Central/South Americans, and non-Hispanic Whites in California to the remaining United States in the 1990s and 2000s.

Methods

Data were analyzed using the 1992-2011 Current Population Survey Tobacco Use Supplement to report the estimated prevalence of smoking status, frequency, and intensity by decade, race/ethnicity, and state residence. Weighted logistic regression explored sociodemographic factors associated with never and heavy smoking (≥20 cigarettes per day).

Results

There were absolute overall increases from 6.8% to 9.6% in never smoking across all groups. Compared to the remaining United States, there was a greater decrease in heavy smoking among Mexican American current smokers in California (5.1%) and a greater increase in light and intermittent smokers among Central/South American current smokers in California (9.3%) between decades. Compared to those living in the remaining United States, smokers living in California had lower odds of heavy smoking (1990s: odds ratio [OR] = 0.64, 95% confidence interval [CI] = 0.62, 0.66; 2000s: 0.54, 95% CI = 0.52, 0.55).

Conclusions

California state residence significantly impacted smoking behaviors as indicated by significant differences in smoking intensity between California and the remaining United States among Hispanic/Latino nationality groups. Understanding smoking behaviors across Hispanic/Latino nationality groups in California and the United States can inform tobacco control and smoking prevention strategies for these groups.

Implications

The present study explored the differences in smoking behaviors between Whites, Mexican Americans, and Central South/Americans living in California versus the rest of the United States in the 1990s and the 2000s. The results contribute to our current knowledge as there have been minimal efforts to provide disaggregated cigarette consumption information among Hispanic/Latino nationality groups. Additionally, by comparing cigarette consumption between those in California and the remaining United States, our data may provide insight into the impact of California's antitobacco efforts in reaching Hispanic/Latino subpopulations relative to the remaining US states, many of which have had less tobacco control policy implementation.

Assimilation and its Discontents: Between Rhetoric and Reality

The process of immigrant assimilation is typically and uncritically conceived as one of linear progress – becoming similar to the dominant group in the place of destination is presumed to be a good thing. But a compelling body of evidence on the adaptation of immigrants and their children points to a deterioration of outcomes over time and generation in the United States, as well as to nonlinear processes of change. While linguistic assimilation among children of immigrants does proceed rapidly and inexorably as a linear function, other outcomes – in such diverse areas as infant and adolescent health, diet and divorce, delinquency and risk behaviors, educational achievement and aspirations, an ethos of hard work, and the development of an ethnic identity – contradict conventional expectations, expose underlying ethnocentric pretensions, and point instead to assimilation's discontents. By examining such paradoxes of immigrant adaptation that emerge in the conceptual interstices between rhetoric and reality, fruitful reformulations of a seminal sociological concept may be stimulated and advanced.

Incidence of lung cancer histologic cell-types according to neighborhood factors: A population based study in California

BACKGROUND

The relationships between neighborhood factors (i.e., neighborhood socioeconomic status (nSES) and ethnic enclave) and histologic subtypes of lung cancer for racial/ethnic groups, particularly Hispanics and Asian American/Pacific Islanders (AAPIs), are poorly understood.

METHODS

We conducted a population-based study of 75,631 Californians diagnosed with lung cancer from 2008 through2012. We report incidence rate ratios (IRRs) for lung cancer histologic cell-types by nSES among racial/ethnic groups (non-Hispanic (NH) Whites, NH Blacks, Hispanics and AAPIs) and according to Hispanic or Asian neighborhood ethnic enclave status among Hispanics and AAPIs, respectively. In addition, we examined incidence jointly by nSES and ethnic enclave.

RESULTS

Patterns of lung cancer incidence by nSES and ethnic enclave differed across race/ethnicity, sex, and histologic cell-type. For adenocarcinoma, Hispanic males and females, residing in both low nSES and high nSES neighborhoods that were low enclave, had higher incidence rates compared to those residing in low nSES, high enclave neighborhoods; males (IRR, 1.17 [95% CI, 1.04-1.32] and IRR, 1.15 [95% CI, 1.02-1.29], respectively) and females (IRR, 1.29 [95% CI, 1.15-1.44] and IRR, 1.51 [95% CI, 1.36-1.67], respectively). However, AAPI males residing in both low and high SES neighborhoods that were also low enclave had lower adenocarcinoma incidence.

CONCLUSIONS

Neighborhood factors differentially influence the incidence of lung cancer histologic cell-types with heterogeneity in these associations by race/ethnicity and sex. For Hispanic males and females and AAPI males, neighborhood ethnic enclave status is strongly associated with lung adenocarcinoma incidence.

Daily and Nondaily Smoking Varies by Acculturation among English-Speaking, US Latino Men and Women

Background

Higher smoking prevalence and quantity (cigarettes per day) has been linked to acculturation in the United States among Latinas, but not Latino men. Our study examines variation between a different and increasingly important target behavior, smoking level (nondaily vs daily) and acculturation by sex.

Methods

An online English-language survey was administered to 786 Latino smokers during July through August 2012. The Brief Acculturation Rating Scale for Mexican Americans-II (ARSMA-II) and other acculturation markers were used. Multinomial logistic regression models were implemented to assess the association between smoking levels (nondaily, light daily, and moderate/heavy daily) with acculturation markers.

Results

Greater ARMSA-II scores (relative risk ratio, RRR=.81, 95% CI: .72-.91) and being born inside the United States (RRR=.42, 95% CI: .24-.74) were associated with lower relative risk of nondaily smoking. Greater Latino orientation (RRR=1.29, 95% CI: 1.11-1.48) and preference for Spanish language (RRR=1.06, 95% CI: 1.02-1.10) and media (RRR=1.12, 95% CI: 1.05-1.20) were associated with higher relative risk of nondaily smoking. The relationship between acculturation and smoking level did not differ by sex.

Conclusion

This study found that among both male and female, English-speaking Latino smokers, nondaily smoking was associated with lower acculturation, while daily smoking was linked with higher acculturation.

The "Hispanic mortality paradox" revisited: Meta-analysis and meta-regression of life-course differentials in Latin American and Caribbean immigrants' mortality

The literature on immigrant health has repeatedly reported the paradoxical finding, where immigrants from Latin American countries to OECD countries appear to enjoy better health and greater longevity, compared with the local population in the host country. However, no previous meta-analysis has examined this effect focusing specifically on immigrants from Latin America (rather than Hispanic ethnicity) and we still do not know enough about the factors that may moderate the relationship between immigration and mortality. We conducted meta-analyses and meta-regressions to examine 123 all-cause mortality risk estimates and 54 cardiovascular mortality risk estimates from 28 publications, providing data on almost 800 million people. The overall results showed that the mean rate ratio (RR) for immigrants vs. controls was 0.92 (95% CI, 0.84-1.01) for all-cause mortality and 0.73 (CI, 0.67-0.80) for cardiovascular mortality. While the overall results suggest no immigrant mortality advantage, studies that used only native born persons as controls did find a significant all-cause mortality advantage (RR, 0.86; 95% CI, 0.76-0.97). Furthermore, we found that the relative risk of mortality largely depends on life course stages. While the mortality advantage is apparent for working-age immigrants, it is not significant for older-age immigrants and the effect is reversed for children and adolescents.

Acculturation-related predictors of very light smoking among Latinos in California and nationwide

The prevalence of light smoking has increased among Latinos. The purpose of this study was to identify demographic and acculturation-related factors associated with very light smoking, defined as smoking 1-5 cigarettes per day (CPD), among Latinos in California and nationwide. Latino smokers in the 2007-2008 National Health and Nutrition Examination Survey (NHANES) or the 2009 California Health Interview Survey (CHIS) were analyzed. Logistic regression assessed factors associated with very light smoking. Among NHANES smokers, those born in Mexico or who lived fewer years in the US were more likely to be very light smokers than 6+ CPD smokers. Among CHIS smokers, those born in Mexico, in another Spanish speaking country, or who spent smaller percentages of their life in the US were more likely to be very light smokers. Findings from this study can be used to design tobacco control media campaigns that include very light smokers.

Changes in Smoking Intensity Over Time by Birth Cohort and by Latino National Background, 1997-2014

INTRODUCTION

The purpose of the study was to describe changes in smoking intensity among US Latinos and non-Latinos from 1997 to 2014.

METHODS

National Health Interview Survey data between 1997 and 2014 were used to determine the number of cigarettes smoked per day (CPD) among Latino and non-Latino adults who had smoked at least 100 cigarettes in their lifetime and were currently smoking every day or some days (ie, current smokers).

RESULTS

CPD declined steadily throughout the observation period and were consistently lower for Latino than for non-Latino smokers. However, decreases were not equal across birth cohorts, genders, or among Latino national background groups. CPD declined most among Mexican men and least among younger generations, Cuban women, and acculturated Latina women. Additionally, declines in smoking intensity seemed to slow over time among low CPD consumers.

CONCLUSIONS

Although smoking intensity has decreased substantially since the late 1990s, CPD data suggest that declines are slowing among younger generations and certain Latina women. Effective tobacco control strategies should be developed to discourage even very light and nondaily smoking.

IMPLICATIONS

Few studies have been conducted on how smoking intensity has changed since the late 1990s. Between 2004 and 2011, when the decline in smoking prevalence slowed, it is unknown how smoking intensity (ie, CPD) changed by age. Additionally, no research has assessed differences and changes in smoking intensity over time among Latinos. From this study we learned that smoking intensity declined significantly since the late 1990s, but this decline slowed among younger generations of smokers and certain Latina women. Findings suggest that future patterns of smoking intensity may only marginally decline in the near future.

Factors Affecting Cigarette Smoking and Intention to Smoke Among Puerto Rican-American High School Students

Using data from a survey of Puerto Rican adolescents in Boston and Hartford, a cross-sectional analysis was conducted of factors affecting recent cigarette smoking status and intentions to smoke in the next 5 years. Among Puerto Rican-American high school students between the ages of 14 and 20 years, nearly 12% of the males and 10% of the females had smoked at least one cigarette during the month prior to in-home interviews. Two factors -the proportion of close friends who smoked and exposure to smokers during recreational activities-were positively associated with the likelihood that respondents had smoked in the past month and intended to smoke in the future. The smoking status offamily members had no major independent effects on a teen's behavior. Degree of acculturation, measured by three language usage items, was associated with higher rates of smoking by male students but not by females. These results suggest that peer pressure is as important an influence on the cigarette smoking behavior of Puerto Ricans as it is for non-Latino students.

Smoking Behavior of Puerto Rican Women: Evidence from Caretakers of Adolescents in Two Urban Areas

This study examines cigarette smokingpatterns amongPuertoRican women responsible for caring for adolescents in two metropolitan areas in the Northeastern United States. The age-adjusted prevalence of cigarette smoking in the caretaker sample was higher than the rates for all adult women in the 1985 National Health Interview Survey and the 1986 Adult Use of Tobacco Survey. Smoking prevalence among the caretakers was very similar to the rate reported byPuertoRican women in theNew York City area interviewed during the Hispanic Health and Nutrition Examination Survey. Logistic regression analysis indicated that educational attainment, religious affiliation and marital status influenced the probability that a caretaker currently smokeL Acculturation had a modest positive effect on current smoking. Puerto Rican women may be an important target group for smoking cessation programs because quit rates among ever smokers are still comparatively low and because many of these women are light smokers.

Latino Cigarette Smoking Patterns by Gender in a US-National Sample

BACKGROUND

Latino smokers are a rising public health concern who experience elevated tobacco-related health disparities.

PURPOSE

Additional information on Latino smoking is needed to inform screening and treatment.

ANALYSIS

Latent class analysis using smoking frequency, cigarette preferences, onset, smoking duration, cigarettes per day, and minutes to first cigarette was used to create multivariate latent smoking profiles for Latino men and women.

RESULTS

Final models found seven classes for Latinas and nine classes for Latinos. Despite a common finding in the literature that Latino smokers are more likely to be low-risk intermittent smokers, the majority of classes for both males and females described patterns of high-risk daily smoking. Gender variations in smoking classes were noted.

CONCLUSIONS

Several markers of smoking risk were identified among both male and female Latino smokers, including long durations of smoking, daily smoking, and preference for specialty cigarettes, all factors associated with long-term health consequences.

Intergenerational transmission of the effects of acculturation on health in Hispanic Americans: a fetal programming perspective

We propose a transdisciplinary, life span framework for examining the underlying cause of the observed intergenerational decline in health among Hispanic Americans. We focus on acculturation, and we posit that acculturation-related processes in first-generation Hispanic immigrant mothers may affect the intrauterine development of an unborn child, via the process of fetal programming, to produce phenotypic effects that may alter the susceptibility for noncommunicable chronic diseases. In this manner, an intergenerational cascade of perpetuation may become established. Our framework may shed light on the biological, behavioral, and social causes of intergenerational cycles of vulnerability among immigrant minority groups, with public health and policy implications for primary prevention and intervention.

Is greater acculturation associated with an increased prevalence of cardiovascular risk factors among Latinos in South Florida?

OBJECTIVE

To examine the association of acculturation with various cardiovascular risk factors (CRFs) among Latinos with diabetes in South Florida.

METHODS

In a cross-sectional analysis of data collected from 300 Latinos with poorly controlled diabetes we measured acculturation using the Marin Short Acculturation Scale. We examined correlations between acculturation and the following 7 CRFs: hemoglobin A1C, low-density lipoprotein, systolic blood pressure, body mass index, smoking status, physical activity, and fruit and vegetable intake.

RESULTS

Cubans made up 38% of our population; no other Latino subgroup represented over 17% of the sample. Of the 8 outcomes examined, only smoking was associated with increased acculturation; 12% of Latinos in the 2 lowest acculturation groups were current smokers versus 25% in the highest acculturation group (P=0.02). Furthermore, Cuban Americans from our sample had over double the prevalence of smoking compared with non-Cubans in both the lowest and highest acculturation groups.

CONCLUSIONS

With the exception of smoking, our data does not support a link between increased acculturation and higher prevalence of CRFs in Latinos with diabetes. Smoking prevention and cessation programs targeting Latinos and particularly among Cubans are needed.

Smoking among U.S. Hispanic/Latino adults: the Hispanic community health study/study of Latinos

BACKGROUND

Prior national surveys capture smoking behaviors of the aggregated U.S. Hispanic/Latino population, possibly obscuring subgroup variation.

PURPOSE

To describe cigarette use among Hispanic/Latino adults across subgroups of age, gender, national background, SES, birthplace, and degree of acculturation to the dominant U.S. culture.

METHODS

A cross-sectional survey of 16,322 participants in the Hispanic Community Health Study/Study of Latinos aged 18-74 years, recruited in Bronx NY, Chicago IL, Miami FL, and San Diego CA, was conducted during 2008-2011.

RESULTS

Prevalence of current smoking was highest among Puerto Ricans (men, 35.0%; women, 32.6%) and Cubans (men, 31.3%; women, 21.9%), with particularly high smoking intensity noted among Cubans as measured by pack-years and cigarettes/day. Dominicans had the lowest smoking prevalence (men, 11.0%; women, 11.7%). Individuals of other national backgrounds had a smoking prevalence that was intermediate between these groups, and typically higher among men than women. Non-daily smoking was common, particularly although not exclusively among young men of Mexican background. Persons of low SES were more likely to smoke, less likely to have quit smoking, and less frequently used over-the-counter quit aids compared to those with higher income and education levels. Smoking was more common among individuals who were born in the U.S. and had a higher level of acculturation to the dominant U.S. culture, particularly among women.

CONCLUSIONS

Smoking behaviors vary widely across Hispanic/Latino groups in the U.S., with a high prevalence of smoking among population subgroups with specific, readily identifiable characteristics.

National trends in smoking behaviors among Mexican, Puerto Rican, and Cuban men and women in the United States

OBJECTIVES

We examined trends in smoking behaviors across 2 periods among Mexicans, Puerto Ricans, and Cubans in the United States.

METHODS

We analyzed data from the 1992-2007 Tobacco Use Supplements to the Current Population Survey. We constructed 2 data sets (1990s vs 2000s) to compare smoking behaviors between the 2 periods.

RESULTS

Significant decreases in ever, current, and heavy smoking were accompanied by increases in light and intermittent smoking across periods for all Latino groups, although current smoking rates among Puerto Rican women did not decline. Adjusted logistic regression models revealed that in the 2000s, younger Mexicans and those interviewed in English were more likely to be light and intermittent smokers. Mexican and Cuban light and intermittent smokers were less likely to be advised by healthcare professionals to quit smoking. Mexicans and Puerto Ricans who were unemployed and Mexicans who worked outdoors were more likely to be heavy smokers.

CONCLUSIONS

Increases in light and intermittent smoking among Mexican, Puerto Rican, and Cuban Americans suggest that targeted efforts to further reduce smoking among Latinos may benefit by focusing on such smokers.

Demographic and migration-related risk factors for low-level smoking in a farm working sample of Latinos (the MICASA study)

Cigarette smoking is the most preventable cause of death in the U.S. Research regarding the phenomenon of low-level smoking, defined as smoking one to five cigarettes per day (CPD) on average, is increasing as its high prevalence is better recognized. The Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study is a prospective cohort study of Latino hired farm worker families that assesses respiratory health, including patterns and behaviors of cigarette smoking. The purpose of the present analysis was to establish demographic, migration-related, and psychosocial characteristics and risk factors for low-level smoking. Seven percent of participants were current smokers, 61% of them being low-level smokers. Low-level smokers did not smoke as many days during the past month as those who smoke 6+ CPD (p=0.04). Low-level smokers were more likely than never and former smokers combined not to be married and to experience frequent mental distress. Those who smoke 6+ CPD were also more likely than never and former smokers combined to experience frequent mental distress and to be more acculturated. Low-level smokers have characteristics and risk factors that set them apart from other types of smokers. This increased understanding of low-level smokers can enhance public health education and smoking cessation programs targeted at Latinos.

Disparity in disaster preparedness between racial/ethnic groups

Objective

The objective of this study was to examine the association between race/ethnicity (including language subgroups among Hispanics) and disaster preparedness among Behavioral Risk Factor Surveillance System (BRFSS) survey respondents.

Methods

BRFSS data were obtained for eight states which implemented the optional general preparedness module from 2006 through 2010. Three dependent variables were analyzed including presence of four preparedness items (i.e., food, water, flashlight, and radio), emergency evacuation plan, and 3-d supply of medication. Primary independent variable included race/ethnicity accounting for language of survey. Data were analyzed in 2011 and accounted for BRFSS sampling design.

Results

Black (OR = 0.66, 95% CI = 0.56, 0.79), English-speaking Hispanic (OR = 0.48, 95% CI = 0.34, 0.69) and Spanish-speaking Hispanic respondents (OR = 0.20, 95% CI = 0.13, 0.29) were less likely than non-Hispanic white respondents to live in a household in which all members requiring medication had a 3-d supply. Results varied regarding presence of four preparedness items and an emergency evacuation plan.

Conclusions

Racial/ethnic minority groups were less likely to have medication supplies but only Spanish-speaking Hispanics were less likely to have an emergency evacuation plan than white respondents. Public health officials can use these findings to support targeting racial/ethnic minorities to increase the presence of preparedness items important to mitigate the effects of disasters, with particular emphasis on medication supplies and Spanish-speaking Hispanics.

Level of cigarette consumption and quit behavior in a population of low-intensity smokers--longitudinal results from the International Tobacco Control (ITC) survey in Mexico

BACKGROUND

Mexican smokers are more likely to be non-daily smokers and to consume fewer cigarettes per day than smokers in other countries. Little is known about their quit behaviors.

AIM

The aim of this study is to determine factors associated with having made a quit attempt and being successfully quit at 14-month follow-up in a population-based cohort of adult Mexicans who smoke at different levels of intensity.

DESIGN

A longitudinal analysis of wave-III and wave-IV (2010) Mexican administration of International Tobacco Control Policy Evaluation Project was conducted.

SETTING

This study was conducted in six large urban centers in Mexico

PARTICIPANTS

The participants of this study comprised 1206 adults who were current smokers at wave-III and who were followed to wave-IV.

MEASUREMENTS

We compared three groups of smokers: non-daily smokers-who did not smoke every day in the past 30 days (n=398), daily light smokers who smoked every day at a rate of ≤5 cigarettes per day (n=368) and daily heavy smokers who smoked every day at a rate of >5 cigarettes per day (n=434). Data on smoking behavior, psychosocial characteristics and socio-demographics were collected at baseline and after 14 months.

FINDINGS

In multivariate logistic regression predicting having made a quit attempt at follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=1.83, 95% CI: 1.19-2.83), less perceived addiction (ORadj=1.86, 95% CI: 1.20-2.87), greater worry that cigarettes will damage health (ORadj=2.04, 95% CI: 1.16-3.61) and having made a quit attempt in the past year at baseline (ORadj=1.70, 95% CI: 1.23-2.36). In multivariate logistic regression predicting being successfully quit at one-year follow-up, significant factors included being a non-daily smoker versus a heavy daily smoker (ORadj=2.54, 95% CI: 1.37-4.70) and less perceived addiction (not addicted: ORadj=3.26, 95% CI: 1.73-6.14; not much: ORadj=1.95, 95% CI: 1.05-3.62 versus very much).

CONCLUSIONS

Mexican adult smokers who are non-daily smokers were more likely than daily heavy smokers to have attempted to quit during follow-up and to succeed in their quit attempt. Future research should determine whether tobacco control policies and programs potentiate this tendency and which interventions are needed to help heavier smokers to quit.

A historical review of R.J. Reynolds' strategies for marketing tobacco to Hispanics in the United States

Hispanics are the fastest growing racial/ethnic group in the United States, and smoking is the leading preventable cause of morbidity and mortality among this population. We analyzed tobacco industry documents on R. J. Reynolds' marketing strategies toward the Hispanic population using tobacco industry document archives from the Legacy Tobacco Documents Library (http://legacy.library.ucsf.edu) between February-July 2011 and April-August 2012. Our analysis revealed that by 1980 the company had developed a sophisticated surveillance system to track the market behavior of Hispanic smokers and understand their psychographics, cultural values, and attitudes. This information was translated into targeted marketing campaigns for the Winston and Camel brands. Marketing targeted toward Hispanics appealed to values and sponsored activities that could be perceived as legitimating. Greater understanding of tobacco industry marketing strategies has substantial relevance for addressing tobacco-related health disparities.

Preterm, low-birth-weight deliveries, and farmwork among Latinas in California

OBJECTIVE

To examine the association between preterm and low-birth-weight (PTLBW) delivery and maternal occupation among Latina women in California.

METHODS

A cohort of 1024 Latina women in Stockton, California, was observed from baseline to delivery. The association between PTLBW delivery and maternal occupation (farmwork, nonfarmwork, no work) was analyzed using multiple logistic regression models.

RESULTS

Demographic characteristics varied widely between the three occupation groups. The adjusted odds ratio of a PTLBW delivery for farmworkers compared with women who did not work was 1.28 (95% CI, 0.65 to 2.54).

CONCLUSIONS

We did not observe a statistically significant association between PTLBW delivery and farmwork in this population. Nevertheless, the relationship between acculturation and risky health behaviors suggests that studies investigating the association between maternal employment and adverse pregnancy outcomes among Latinas need to account for a participant's acculturation status.

A pilot binational study of health behaviors and immigration

In the US, Mexican immigrant women often have better health outcomes than non-Hispanic white women despite a greater health risk profile. This cross-sectional pilot study compared women living in Chavinda, Michoacán (n = 102) to women who had migrated from Mexico to Madera, California (n = 93). The interview gathered information on acculturation and risk behaviors including smoking, alcohol use and number of sexual partners. The results suggest that more acculturated women living in the US are more likely to consume alcohol. US residence and higher acculturation level was marginally associated with having more than one sexual partner. There were no differences between odds of smoking among Chavinda and Madera women. While results with acculturation are not consistently significant due to small sample sizes, the results are suggestive that acculturation among immigrant Hispanic women in the US may be associated with adverse health behaviors, and selective migration seems less likely to account for these differences.

A review on the oral health impacts of acculturation

The impact of acculturation on systemic health has been extensively investigated and is regarded as an important explanatory factor for health disparity. However, information is limited and fragmented on the oral health implications of acculturation. This study aimed to review the current evidence on the oral health impact of acculturation. Papers were retrieved from five electronic databases. Twenty-seven studies were included in this review. Their scientific quality was rated and key findings were summarized. Seventeen studies investigated the impacts of acculturation on the utilization of dental services; among them, 16 reported positive associations between at least one acculturation indicator and use of dental services. All 15 studies relating acculturation to oral diseases (dental caries and periodontal disease) suggested better oral health among acculturated individuals. Evidence is lacking to support that better oral health of acculturated immigrants is attributable to their improved dental attendance. Further researches involving other oral health behaviors and diseases and incorporating refined acculturation scales are needed. Prospective studies will facilitate the understanding on the trajectory of immigrants’ oral health along the acculturation continuum.

Maternal and infant health of Mexican immigrants in the USA: the effects of acculturation, duration, and selective return migration

BACKGROUND

A significant body of research on minority health shows that while Hispanic immigrants experience unexpectedly favorable outcomes in maternal and infant health, their advantage deteriorates with increased time of residence in the USA. This is referred to as the 'acculturation paradox.'

OBJECTIVE

We assess the 'acculturation paradox' hypothesis that attributes this deterioration in birth and child health outcomes to negative effects of acculturation and behavioral adjustments made by immigrants while living in the USA, and investigate the potential for the existence of a selective return migration.

DESIGN

We use a sample of Mexican immigrant women living in two Midwestern communities in the USA to analyze the effects of immigrant duration and acculturation on birth outcomes once controlling for social, behavioral, and environmental determinants of health status. These results are verified by conducting a similar analysis with a nationally representative sample of Mexican immigrants.

RESULTS

We find duration of residence to have a significant and nonlinear relationship with birth outcomes and acculturation to not be statistically significant. The effect of mediators is minimal.

CONCLUSION

The analyses of birth outcomes of Mexican immigrant women shows little evidence of an acculturation effect and indirectly suggest the existence of a selective return migration mechanism.

Cigarette smoking among adult Latinos: the California Tobacco Baseline Survey

This article presents probability estimates of smoking prevalence for the Latino adult population in California and examines differences in smoking prevalence and nicotine dependence between different levels of education and acculturation and between different ethnic and gender groups. Prevalence estimates are based on the California Baseline Tobacco Survey (CTS). The CTS is a Random Digit Dial Survey including N=70,997 non-Latino Whites and 28,000 Latino adults. Overall smoking prevalence among Latinos was estimated at 24.4% for men and 12.0% for women. Multiple logistic regression analyses suggest higher smoking prevalence and higher nicotine dependence for men than for women, for individuals who have not finished high school, for non-Latinos when compared to Latinos, and for Latinos of high level of acculturation when compared to Latinos of low level of acculturation. These estimates can serve as baselines to evaluate progress toward year 2000 health objectives. Findings stress the importance of taking into account socio-economic level when comparing Latinos and other ethnic groups on health behaviors. Moreover, findings suggest that interventions helping Latinos quit smoking are most needed for men with twelve years or less of formal education and stress the importance of programs to prevent smoking uptake, specifically among Latinos of low level of acculturation.

Difference in airflow obstruction between Hispanic and non-Hispanic White female smokers

Smoking-related respiratory diseases are a major cause of morbidity and mortality. However, the relationship between smoking and respiratory disease has not been well-studied among ethnic minorities in general and among women in particular. The objective of this cross-sectional study was to evaluate the risk of airflow obstruction and to assess lung function among Hispanic and non-Hispanic White (NHW) female smokers in a New Mexico cohort. Participants completed a questionnaire detailing smoking history and underwent spirometry testing. Outcomes studied included airflow obstruction, selected lung function parameters, and chronic mucus hyper-secretion. Chi square, logistic, and linear regression techniques were utilized. Of the 1,433 eligible women participants, 248 (17.3%) were Hispanic; and 319 had airflow obstruction (22.3%). Hispanic smokers were more likely to be current smokers, and report lower pack-years of smoking, compared to NHW smokers (p < 0.05 for all analyses). Further, Hispanic smokers were at a reduced risk of airflow obstruction compared to NHW smokers, with an O.R. of 0.51, 95% C.I. 0.34, 0.78 (p = 0.002) after adjustment for age, BMI, pack-years and duration of smoking, and current smoking status. Following adjustment for covariates, Hispanic smokers also had a higher mean absolute and percent predicted post-bronchodilator FEV(1)/FVC ratio, as well as higher mean percent predicted FEV(1) (p < 0.05 for all analyses). Hispanic female smokers in this New Mexico-based cohort had lower risk of airflow obstruction and better lung function than NHW female smokers. Further, smoking history did not completely explain these associations.

Nativity and cigarette smoking among lower income blacks: results from the Healthy Directions Study

Blacks in the United States bear the greatest disease burden associated with cigarette smoking. Previous studies have shown that the rapidly increasing population of foreign-born Blacks has lower smoking rates compared to their native-born counterparts. However, less is known about whether cigarette smoking among Blacks varies by region of birth (US, Africa, or the Caribbean), generational status, or acculturation. We examined the association between nativity and cigarette smoking among 667 Black adult men and women enrolled in the Harvard Cancer Prevention Program project. In multi-variable analyses, US-born Blacks were more likely to be smokers compared to those born in the Caribbean (OR = 0.16, 95% CI 0.08, and 0.34) or in Africa (OR = 0.24, 95% CI 0.08, and 0.74). Language acculturation was positively associated with cigarette smoking (OR = 2.62, 95% CI 1.17, and 5.85). We found that US-born Blacks were more likely to be current cigarette smokers than those born in either Caribbean or African countries. Our findings highlight the importance of intervening early new Black immigrants to stem the uptake of cigarette smoking behaviors as individuals become acculturated.

Association between length of residence and cardiovascular disease risk factors among an ethnically diverse group of United States immigrants

BACKGROUND

Although differences in cardiovascular disease (CVD) risk factors between immigrants and nonimmigrants have been examined previously, the effect of acculturation on CVD risk factors in immigrants has been less well studied.

OBJECTIVE

To determine the association between length of U.S. residence (proxy for acculturation) and major CVD risk factors.

METHODS

Data on 5,230 immigrant adults from the 2002 National Health Interview Survey (NHIS) was analyzed. Primary independent variable was length of U.S. residence < 10, 10 to < 15, and > or = 15 years. Main outcome measures included obesity, hypertension, diabetes, hyperlipidemia, smoking, and physical inactivity. Multiple logistic regression was used to assess the association between length of residence and odds of multiple CVD risk factors adjusting for confounders. SAS-callable SUDAAN was used for statistical analysis.

RESULTS

Among the patients, 55.4% were obese, 17.3% had hypertension, 15.9% had hyperlipidemia, 6.6% had diabetes, 79.3% were physically inactive, and 14.3% were smokers. Using < 10 years as reference, those with length of residence > or = 15 years were more likely to be obese (OR 1.31, 95% CI 1.03-1.65), have hyperlipidemia (OR 1.59, 95% CI 1.14-2.22), and be smokers (OR 1.39, 95% CI 1.04-1.85). Length of residence > or = 15 years was associated with decreased odds of sedentary lifestyle (OR 0.63, 95% CI 0.47-0.84). Length of residence > or = 15 years was not associated with odds of having diabetes (OR 1.40, 95% CI 0.78-2.51) or hypertension (OR 1.21, 95% CI 0.86-1.71).

CONCLUSIONS

Among immigrants from diverse ethnic backgrounds, longer length of residence in the United States is associated with increased odds of obesity, hyperlipidemia, and cigarette smoking even after adjusting for relevant confounding factors.

Cultural traditions as "protective factors" among Latino children of illicit drug users

Family bonding was examined among Hispanic adolescents whose fathers are illicit drug users to ascertain whether such adolescents maintain close affective family ties or alienate themselves from their families given their father's use of illicit drugs and referral to a drug screening and treatment program. It was hypothesized that high levels of paternal drug use would be associated with the youth's alienation from the family. In addition, it was postulated that the adolescent's endorsement of traditional cultural values and social responsibility would protect her or him against this effect in relation to family bonding. These hypotheses are based on prior research that suggests that youth bonding to prosocial institutions, such as family, school, church, and community organizations, can be "protective" against drug use. More specifically, our analyses examined the role of level of acculturation in middle school, family traditionalism, American orientation, Latino orientation, and social responsibility in predicting adolescents' family bonding. Results indicated that the father's level of marijuana and/or methamphetamine use was unrelated to youth family bonding. Additionally, Latino and American cultural orientations and level of acculturation in middle school were not associated with family bonding. By contrast, social responsibility (the youth's citizenship and responsibility to the community) and family traditionalism (endorsing conservative cultural values regarding the maintenance of family traditions and respect for elders and family) were significantly associated with family bonding. In other words, among children of Latino illicit drug users, the youth's conservative family values and a responsible attitude toward community traditions were dual factors related to family bonding, perhaps operating also as sources of "protection" against youth problem behaviors.

Toward a theory-driven model of acculturation in public health research

Interest in studying the impact of acculturation on immigrant health has increased in tandem with the growth of the Latino population in the United States. Linear assimilation models continue to dominate public health research despite the availability of more complex acculturation theories that propose multidimensional frameworks, reciprocal interactions between the individual and the environment, and other acculturative processes among various Latino groups. Because linear and unidimensional assessments (e.g., nativity, length of stay in the United States, and language use) provide constricted measures of acculturation, the rare use of multidimensional acculturation measures and models has inhibited a more comprehensive understanding of the association between specific components of acculturation and particular health outcomes. A public health perspective that incorporates the roles of structural and cultural forces in acculturation may help identify mechanisms underlying links between acculturation and health among Latinos.

Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox

Relative to non-Latino whites, Latinos in the United States have a lower socioeconomic status (SES) profile, but a lower all-cause mortality rate. Because lower SES is associated with poorer overall health, a great deal of controversy surrounds the Latino mortality paradox. We employed a secondary data analysis of the 1991 National Health Interview Survey to test the health behavior and acculturation hypotheses, which have been proposed to explain this paradox. These hypotheses posit that: (1) Latinos have more favorable health behaviors and risk factor profiles than non-Latino whites, and (2) Health behaviors and risk factors become more unfavorable with greater acculturation. Specific health behaviors and risk factors studied were: smoking, alcohol use, leisure-time exercise activity, and body mass index (BMI). Consistent with the health behaviors hypothesis, Latinos relative to non-Latino whites were less likely to smoke and drink alcohol, controlling for sociodemographic factors. Latinos, however, were less likely to engage in any exercise activity, and were more likely to have a high BMI compared with non-Latino whites, after controlling for age and SES. Results provided partial support for the acculturation hypothesis. After adjusting for age and SES, higher acculturation was associated with three unhealthy behaviors (a greater likelihood of high alcohol intake, current smoking, a high BMI), but improvement in a fourth (greater likelihood of recent exercise). Gender-specific analyses indicated that the observed differences between Latinos and non-Latino whites, as well as the effects of acculturation on health behaviors, varied across men and women. Results suggest that the health behaviors and acculturation hypotheses may help to at least partially explain the Latino mortality paradox. The mechanisms accounting for the relationship between acculturation and risky behaviors have yet to be identified.

Acculturation and smoking patterns among Hispanics: a review

OBJECTIVE

To conduct a systematic review of published studies investigating the association of acculturation and smoking patterns among Hispanic men and women in the United States.

METHODS

Online bibliographic databases were searched from 1985 to 2003 using three key search terms. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study population, study methods, exposure assessment, outcomes measured, acculturation measures used, and results.

RESULTS

The literature search identified 78 articles from MEDLINE, PubMed, and PsychINFO databases; of these, 11 studies met the inclusion criteria. Seven regional studies based in the western United States and four nationwide studies were included in the review. Seven studies used formal acculturation scales, three used language spoken, and one used language spoken and country of birth to indicate acculturation status. Nine studies showed a positive association between acculturation and smoking among women, and one study involving men showed a negative association.

CONCLUSIONS

The findings suggest that the association of acculturation and smoking is gender-specific. In this instance, increased smoking prevalence with increased acculturation is consistently observed among Hispanic women but not among men. As Hispanic women acculturate, their cigarette smoking may increase because their behavior becomes more strongly influenced by the norms and practices of the dominant group than among men. Immigrant- and gender-specific public health interventions need to be designed to combat the increase in smoking rates among Hispanics in the United States.

Creatinine levels among Mexican Americans, Puerto Ricans, and Cuban Americans in the Hispanic Health and Nutrition Examination Survey

BACKGROUND

Although Latinos constitute the largest and fastest growing minority group in the United States, little is known about the prevalence of renal disease among different Latino subgroups.

METHODS

We used data from the Hispanic Health and Nutrition Examination Survey (HHANES) to compare serum creatinine measurements among Mexican Americans, mainland Puerto Ricans, and Cuban Americans. We compared estimated creatinine clearance across Latino subgroups adjusted for demographic, clinical, and socioeconomic characteristics (including known predictors of chronic kidney disease) using survey logistic regression analysis.

RESULTS

Cuban Americans had higher mean serum creatinine levels than the other groups across both gender and age categories. In multivariable analysis, Puerto Ricans [odds ratio (OR) 1.74, 95% confidence interval (CI) 1.16 to 2.60] and Cuban Americans (OR 4.59, CI 2.53 to 8.31) were more likely than the referent category of Mexican Americans to have an estimated creatinine clearance < 60 mL/min/1.73 m2.

CONCLUSION

Serum creatinine levels differ substantially among Latino subgroups, suggesting national origin needs to be taken into consideration in studies of renal disease in Latinos. In addition, our findings highlight the need for more contemporary studies directly comparing both incidence rates of end-stage renal disease and measured renal function among Latino subgroups, perhaps leading to subgroup-specific prediction equations.

Parent-reported asthma in Puerto Rican children

We conducted a survey to determine parent-reported asthma prevalence, morbidity, and healthcare utilization among 3527 children attending public schools (n = 2849) and private schools (n = 678) in San Juan, Puerto Rico. Schools were randomly selected from each of 12 geographic regions of the San Juan metropolitan area. Parents of children age 4-7 years old completed a 12-item questionnaire on asthma diagnosis, respiratory symptoms and morbidity, and healthcare utilization. Parents of children in public schools and private schools reported similar rates of a physician having previously diagnosed asthma in their children (43.2% vs. 39.4%); however, significantly more children in public schools were reported to still have asthma at the time of the survey (32.6% vs. 23.7%). Children attending public schools vs. private schools were reported to have missed significantly more school and to have had more hospitalizations and emergency department visits. Among children reported to still have asthma, significantly more children visited an emergency department, were hospitalized, and missed more school days due to respiratory symptoms in the past year. The high prevalence of parent-reported asthma, respiratory symptoms, and healthcare utilization among Puerto Rican children in San Juan calls for further studies using objective methods for ascertaining asthma and asthma-related morbidity. Differences in healthcare utilization between children attending public vs. private schools suggest that socioeconomic factors play a role in asthma management in Puerto Rico.

Tobacco use among Mexican farmworkers working in tobacco: implications for agromedicine

This survey evaluated tobacco use of migrant tobacco workers in eastern North Carolina. Sixty-nine (38%) out of 181 mostly male, Mexican farmworkers were smokers. Compared to non-smokers, three times more smokers reported alcohol use in the past week (p=0.002). More smokers compared to non-smokers reported poor to fair health, and fewer had worked previously in tobacco agriculture, but these differences were not statistically significant. Also not statistically significant, those smokers who were older and those who understood the most English smoked more cigarettes per day. Because farmworkers are exposed to many non-tobacco respiratory irritants, and because of the health risks of smoking, those who smoke should be urged to quit.

Lack of acculturation is a risk factor for diabetes in arab immigrants in the US

OBJECTIVE

To examine the relationship between dysglycemia (impaired fasting glucose, impaired glucose tolerance, and diabetes) and acculturation, physical activity, and perceived stress in Arab immigrants in the U.S.

RESEARCH DESIGN AND METHODS

In a cross-sectional population-based study, we examined 520 Arab Americans, aged 20-75 years, who were born in the Middle East and immigrated to southeastern Michigan. Dysglycemia was assessed by history and with a 2-h 75-g oral glucose tolerance test. Acculturation, physical activity, and perceived stress were measured with standardized questionnaires.

RESULTS

Associations were found between dysglycemia in men and older age at immigration, unemployment, speaking Arabic with friends, being less active in Arabic organizations, more frequent consumption of Arabic food, and less integration into American society. Dysglycemia in women was associated with being raised in rural areas of the Middle East, older age at immigration, longer length of stay in the U.S., not being employed outside the home, less than high school education, not attending Arabic or American schools, and not being able to read Arabic. Among men, older age at immigration, shorter length of stay in the U.S., less activity in Arab organizations, and eating Arabic food were associated with dysglycemia independent of age and BMI. Among women, acculturation was very low and was confounded with age and BMI as powerful risk factors for dysglycemia. No association was found between physical activity, perceived stress, and the risk of dysglycemia in either sex.

CONCLUSIONS

Lack of acculturation is an important risk factor for dysglycemia in immigrant Arab Americans. Intervention programs aimed at diabetes prevention should consider the acculturation process.

Smoking as subculture? Influence on Hispanic and non-Hispanic White women's attitudes toward smoking and obesity

Cultural stereotypes might help explain why smoking is less prevalent among Hispanic than non-Hispanic White women, whereas obesity is more prevalent. Hispanic (n = 130) and non-Hispanic White (n = 114) women rated their thoughts and feelings regarding a female smoker and an overweight woman. Ethnicity did not influence evaluations, but attitudes toward smokers were more positive among more acculturated Hispanic women, F(1, 66) = 9.9, p < .01. Less acculturated women evaluated an overweight woman more positively than a smoker, F(1, 28) = 5.65, p < .05; more acculturated women did the opposite, F( 1, 36) = 5.92, p < .05. Smokers evaluated smokers more positively than overweight women, F(1, 86) = 40.8, p < .01; nonsmokers did the opposite, F(l, 138) = 7.7, p < .01. Personal body weight did not influence evaluations. Acculturation and smoking status appear to have a greater influence than ethnicity or weight status on women's attitudes toward smoking and weight.

Research agenda for Hispanics in the United States: a nursing perspective

Heterogeneity is perhaps the most salient characteristic that defines Hispanic populations of the United States. Hispanic populations include native-born, migrant, and immigrant peoples with distinctive national origins and regional settlement patterns. This multigenerational migratory and social adjustment process has produced important cultural variations within and among the respective Hispanic ethnic groups. Moreover, the demographic structure of Hispanic populations is also varied and complex. These historical, demographic, and sociocultural features shape the health and disease experience of Hispanics. As expected, respective Hispanic ethnic groups vary in health status and have differing needs for health services. This article provides demographic background, a historical perspective, a synthesis of Hispanic issues identified in major and authoritative government documents, summary on the state-of-the-science for nursing research with Hispanics, and recommendations for future nursing research directions.

Simulated effect of tobacco tax variation on Latino health in California

BACKGROUND

Over one fourth of the California population was Latino in 1999, and by 2015 Latinos are expected to be the single largest ethnic group in California. Patterns of smoking and nicotine dependence among Latino smokers may be quite different from those of smokers in other ethnic groups. In addition, Latino smokers may be more sensitive to cigarette prices. Therefore, the effect of an increase in cigarette excise taxes on Latino smoking prevalence may be quite large, and consequently the impact on Latino health may be proportionately greater than on population health in general.

METHODS

We simulated changes in Latino smoking, morbidity, mortality, and quality-adjusted life years (QALYs) that would result from a range of actual and proposed cigarette excise-tax increases using a range of cigarette price-elasticity estimates specific to Latino smokers. Monte Carlo simulation was used to generate confidence intervals.

RESULTS

Assuming a Latino price elasticity of demand for cigarettes of -1.0, reductions in Latino smoking resulting from an additional $0.50/pack tax would produce nearly 3000 Latino QALYs in California in 1999. Greater benefits would accrue each year, until a steady state relative to population size is reached 75 years after the program is initiated.

CONCLUSIONS

If Latino smokers are more responsive to changes in cigarette prices than other smokers, Latino smokers also stand to gain a disproportionate share of the health benefit from an excise tax increase.

Cigarette smoking behavior among US Latino men and women from different countries of origin

OBJECTIVES

This study sought to compare smoking behavior among Latino men and women from different countries of origin.

METHODS

A telephone-administered survey was conducted in 8 cities with Latino men and women of different national origin living in census tracts with at least 70% Latino individuals.

RESULTS

A total of 8882 participants completed the survey; 53% were women. The average age of respondents was 44 years; 63% were foreign-born, and 59% preferred Spanish for the interview. Current smoking was more prevalent among men (25.0%, 95% confidence interval [CI] = 23.7, 26.3) than among women (12.1%, 95% CI = 11.1, 13.0). Smoking rates were not significantly different by national origin among men, but Puerto Rican women had higher rates of smoking than other women. Central American men and women had the lowest smoking rates. Foreign-born respondents were less likely to be smokers (odds ratio [OR] = 0.77, 95% CI = 0.66, 0.90) than US-born respondents, and respondents with 12 years or less of education had an increased odds of smoking (OR = 1.17, 95% CI = 1.01, 1.35). High ac culturation was associated with more smoking in women (OR = 1.12, 95% CI = 1.00-1.25) and less smoking in men (OR = 0.86, 95% CI = 0.78-0.95). Puerto Rican and Cuban respondents were more likely to be current smokers and to smoke more than 20 cigarettes per day.

CONCLUSIONS

Older, US-born, and more-educated respondents were less likely to be current smokers. Respondents of Puerto Rican and Cuban origin were more likely to smoke. Acculturation has divergent effects on smoking behavior by sex.

Linguistic acculturation associated with higher marijuana and polydrug use among Hispanic adolescents

Hispanic sixth and seventh graders in 22 New York City middle schools (mean age: 12.66 years) completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana) use and linguistic acculturation at two assessments (N = 1299 at baseline; N = 1038 at 1-year follow-up). Adolescents who spoke English with their parents smoked marijuana more frequently than those who spoke Spanish with their parents at both surveys. By the 1-year follow-up, students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents.